Immunotherapy Administration and Survival for Stage IV Melanoma Patients at Minority-Serving Hospitals

Immunotherapy has transformed outcomes in stage IV melanoma, yet disparities in access persist. Minority-serving hospitals (MSH) disproportionately care for socioeconomically disadvantaged and minority patients, but their impact on immunotherapy use and survival in melanoma is not well defined.

Adults with stage IV melanoma diagnosed from 2012 to 2020 were identified in the National Cancer Database. MSH were defined as the top decile of institutions by proportion of minority patients with melanoma. Outcomes included immunotherapy receipt and overall survival (OS). Logistic regression assessed predictors of immunotherapy receipt. Cox proportional hazards modeling evaluated OS.

Among 19,469 patients, 1279 (6.6%) were treated at MSH. MSH patients were more often Hispanic (20.6% vs. 1.4%), from lower-income and less-educated communities, and had Medicaid or no insurance (all p < 0.001). Immunotherapy was less frequently used at MSH (35.7% vs. 44.7%, p < 0.001). On multivariable analysis, treatment at MSH predicted a lower likelihood of immunotherapy receipt (OR 0.70, 95% CI 0.61-0.81, p < 0.001) and worse OS (HR 1.20, 95% CI 1.07-1.36, p = 0.003).

Stage IV melanoma patients treated at MSH were less likely to receive immunotherapy and had worse survival. These findings highlight institutional disparities beyond patient-level disadvantage and the need for interventions to strengthen access to life-prolonging therapies at MSH.